title: Inflammatory mediators and cerebral embolism in carotid stenting: new markers of risk.
abstract: OBJECTIVE
  To investigate serological predictors of risk for cerebral embolism after carotid artery stenting (CAS).
  
  
  METHODS
  Twenty consecutive symptomatic and asymptomatic patients (13 men; mean age 74 years) with carotid artery stenosis undergoing standardized filter-protected CAS (Wallstent) were preoperatively evaluated to identify unstable plaque (duplex ultrasound), complicated aortic plaque (transesophageal echocardiography), and inflammatory status [high-sensitivity C-reactive protein (hs-CRP) and serum amyloid-A protein (SAA) serum levels]. Aortic arch type, carotid tortuosity, and complexity of the procedure were considered. Cerebral embolism was evaluated by comparing the number, volume, and side (ipsilateral and non-ipsilateral) of preoperative and postoperative cerebral lesions detected on diffusion-weighted resonance magnetic imaging (DW-MRI) and through light and scanning electron microscopy analysis of cerebral protection filters obtained from CAS.
  
  
  RESULTS
  All CAS procedures were completed with no complications. All patients had a negative preoperative DW-MRI, but at least 1 asymptomatic cerebral lesion appeared on DW-MRI after the procedure in 18 (90%) patients. Female gender was associated with a higher number of cerebral lesions (18.2±10.9 vs. 8.3±8.8 for men, p=0.03). Carotid plaque morphology, supra-aortic vessel anatomy, and procedure complexity did not correlate with number or volume of new cerebral lesions. Complicated aortic plaque was associated with a higher volume of non-ipsilateral cerebral lesions than uncomplicated plaque (235.0±259.3 vs. 63.6±63.2 mm(3), respectively; p=0.02). Hs-CRP ≥5 mg/L and SAA ≥10 mg/L were significantly associated with a higher number of new cerebral lesions [16.2±10.7 vs. 4.3±3.4 for hs-CRP <5 mg/L (p=0.02) and 14.8±10.3 vs. 2.8±3.4 for SAA <10 mg/L (p=0.006), respectively]. Hs-CRP ≥5 mg/L and SAA ≥10 mg/L also correlated with greater surface involvement by embolic materials in the protection filters at microscopic analysis [37.0% (5.1%) vs. 26.9% (2.5%) for hs-CRP <5 mg/L, p=0.004; 35.9% (13.5%) vs. 22.2% (6.9%) for SAA <10 mg/L, p=0.02].
  
  
  CONCLUSIONS
  In addition to female gender and the presence of complicated aortic plaque, inflammatory status can be a predictor of cerebral embolism in CAS.
authors.affiliation: 1 Cardio-Thoraco-Vascular Department, S. Orsola-Malpighi Polyclinic, University of Bologna, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Pini
authors.forename: GianLuca
authors.initials: G
authors.lastname: Faggioli
authors.forename: Silvia
authors.initials: S
authors.lastname: Fittipaldi
authors.forename: Gianandrea
authors.initials: G
authors.lastname: Pasquinelli
authors.forename: Caterina
authors.initials: C
authors.lastname: Tonon
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Beltrandi
authors.forename: Raffaella
authors.initials: R
authors.lastname: Mauro
authors.forename: Andrea
authors.initials: A
authors.lastname: Stella
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects* / Q000295:instrumentation*; D001018:Aortic Diseases / Q000150:complications / Q000000981:diagnostic imaging; D058070:Asymptomatic Diseases; D015415:Biomarkers / Q000097:blood; D016893:Carotid Stenosis / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000276:immunology / Q000628:therapy*; D038524:Diffusion Magnetic Resonance Imaging; D017548:Echocardiography, Transesophageal; D057505:Embolic Protection Devices; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D020766:Intracranial Embolism / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology; D008297:Male; D008855:Microscopy, Electron, Scanning; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011474:Prosthesis Design; D012307:Risk Factors; D012737:Sex Factors; D015607:Stents; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators